horse surgery....vacation

I feel like I am on vacation now that I am on large animal surgery. Sure enough the weekend before I switched from small animal medicine to large animal surgery had patients, meaning no days off, but the resident we were on with was SO nice and knew we had worked our asses off too much, so she let us combine patients, and I went in saturday to take care of my and Jess's patients, but then she did the same for me Sunday so I had Sunday off!

So Saturday night I went in to Boston to see "my boy" (whom I am completely smitten with lately). We went shopping so he could get an ipod for his trip, and I bought a new tightly fitting shirt for my jeans. We went out to dinner at Fajitas and Ritas in downtown, then walked over to the Good Life Bar. JM's sister Charlotte was in Boston for her 21 bday and their cousin is this famous DJ from hollywood. He arranged to have a big show in Boston at that bar and all the family and friends of Charlotte got in for free. Mark and I arrived at 9pm before anyone else, and got a drink and had some flirty conversations, mainly about my jeans which I was wearing out for the first time. Eventually everyone showed up, and we had such a great time. We both drank a little too much, but danced a ton and really enjoyed ourselves. I barely remember the taxi ride home.
Sunday we were both a little hung over, but not bad...so we were lazy and stayed in bed until 11 or so. Mark had a cousin's graduation party to go to, and I had nothing to do, so he planned on going and I would wait for him to get back at 5pm. I kind of wanted to go and hinted by asking "When do I get to meet your family?" he laughed and said you should ask to if you want to. He went to the party, and at 5pm called me saying he was so sorry but it was going until 8pm, and said he was a complete idiot for not bringing me along since he missed me and everyone there was asking about me, he said all he did was talk about me. I just laughed and told him about my earlier hint to which he laughed and commented that he was so thick sometimes.

I felt a little guilty about doing NOTHING that day (I took an hour nap, read my book, and watched a movie while Mark was gone), but the next day I started large animal surgery and I felt SO refreshed, so it was totally worth it. Large animal surgery has been like a vacation. I get there at 7am, leave by 5pm, it is AMAZING. Of course, there are a couple 36 hour shifts I have to do coming up this week, but so far it has been so easy and relaxing.

Wednesday night I drove out to somerville and Mark left the key for me so I got there an hour before him and made yummy portabello mushroom burgers and fries, which was a huge hit. Thursday night Mark came out here to see me one more time before leaving for Seattle to visit his brother.

Friday I went in to Boston to Christina's "I Lost 50 Pounds" party, which was fun, I really like some of her friends, but I couldn't stay long. I worked a lot on Saturday, but was able to get a 16 mile run in and go to Ryan's BBQ that night, which was so much fun. We played the card game Terets which was quite comical, and I did really well at it.
Today I went for a 14 mile run in the morning and a kayaking trip in the afternoon since I had the day off. Poor Mark has called me both days form Seattle cause his bro is at a seminar until Monday night and he is a bit lonely and bored. There are things to do in Seattle, but I he is so social and I think he just wants someone to share it with. Got a drink at the Post Office Pub with christina, Pete and Ryan tonight, and now I am catching up on errands before a 12 hour day at the hospital tomorrow...my first overnight in the large animal hospital is Tuesday night, wish me luck! I go in at 7am on Tuesday and stay until 6pm on Wednesday, wow. And I am SO counting down until Friday when Mark comes back and then on Saturday when we go to Montreal to see Heather and company!!!

paint ball pain

So last week I was invited to 7 parties in one week....and of course clinics made it so I only went to one despite trying hard to make most of them. The one party I did make was a 3 hour paintball thing that Katie put together for her bday. Mark came up for the event, funny thing is he used to play paintball a lot in high school, so he was the only expert out of all of us. There were 9 or 10 of us total, and most of us were terrified at first since all the other people there were in camo and had all this pro stuff, but we played each other in a small court first. Of course, I got shot in the one exposed part of my forehead in the first game, and the paint splattered down in to my face on the inside of my mask, and I got some in my mouth which tasted awful so without thinking I spit it out...funny...since I still had a mask on! Overall I only got hurt by one shot in the thigh, and had a great time. I wish I got in to it quicker, I didn't really let loose until the last game, but it was a blast.

I have been so bitter about my schedule lately. I worked too much last week, well, every week for that matter. I am the only student on small animal medicine this time around who has been unlucky enough to have treatment shifts or patients to take care of EVERY weekend, so no days off yet...I am going to beg the doctor on this weekend to let me and jess share cases so we both get a day off, but every other student already got at least one day off. Gulliver, the boxer I want, came back in to tufts to have his ex fix taken care of. I love him and want to adopt him so bad.

Warning, I am going to brag again and hope that it doesn't come back to bite me in the butt cause I prefer to be modest...but Dr. Mahoney had to evaluate us this week today instead of tomorrow since she is off tomorrow. I was not sure what to expect. Dr. Mahoney is very proper, with an irish accent and everything ha!, but she is very formal and nice, but not the joking or laid back type. I warned myself to not expect a great eval since she seemed so distant. Well, I went in to the eval and she started like they all do asking how I thought the week went and asking what I want to do with my life. I ended up talking to her about how I want to go in to wildlife/academia etc., and my past vet experience. At the end of my talking she said "Well, I am sure you will be a great wildlife vet, but I hope you change your mind since you would be an amazing small animal vet. You have great initiative. You have an enthusiasm that is hard to match. And you have a great knowledge base. You write wonderful SOAPs and reports, and you know an incredible amount for this point in your career. I just hope that you keep small animal medicine in the back of your mind as a potential career option in the future cause you would be a great asset to the profession." Nice. : ) I was so flattered I did not know what to say other then smile and thank her a lot, and turn a bit red.

getting better, I think

My last week of small animal medicine is going much better so far. I am really starting to feel comfortable with th cases and am realizing I know more then I thought. Dr. Mahoney who we are on with this week is amazing and is very efficient and works like me, which is great. Plus our schedule is better.

I got my first week of surgery grade back, 95, A! Yay! Maybe Dr. Freeman was right and my GPA will go up a bit with clinics.

I also forgot how nice it is to be in a relationship with someone and actually have some constant support when you are stressed. I've been single for awhile and have loved it for the most part, learned a lot, grew up a lot, and handled a lot on my own with ease. Needless to say you can tell from my posts these last couple weeks have been stressful. And I just want to comment that I have felt so lucky to have someone who is picking up on my feelings better then me at times and helping me de-stress. This of course does not devalue my amazing friends, I love you all and would not survive without you. You guys are amazing.

I still also think that the amount of hours required of us in vet school is unreasonable. But what can you do? Mark keeps joking about how working in the real world is so much different and more difficult, but I have to disagree with veterinary medicine. Even the vets that are out there working still complain about clinics and say things like "Oh my god I wanted to kill myself that year, it was insane, but I got through it, and it is so much better now that I am working. You will get thru it and it will be fine once you finish vet school." I mean, it is not healthy to work at least 75 hours every week, with one day off or less a month. My running is suffering...I try to run at night when I et home, which is usually after 7 after a 13 or more hour day, and I am so slow and tired and for the first time in two years I am not enjoying running. I know this is probably crazy, but I am going to try to change that tomorrow. I am going to start trying to get up at 4am and go for a run before school so that I am refreshed like I love at the begining of the day, and then I will try to go to bed by 8pm as soon as I get home every night...we'll see how this goes.

burn out...

I think I officially have burn out, hopefully it doesn't last long. I figured out how many hours I put in at the hospital in the last 7 days (1 week)...86!!! And I also realized that in the last 9 weeks since I started clinics I have only officially had 2 days off where I did not need to come in to the hospital, and on one of those two days I ran the Boston Marathon. Fuck. I have no missed 5/7 parties this week....hopefully I will make the two remaining ones tomorrow. But all I feel like doing now is curling up on the couch and crying since I feel like I can't get any of my work done. I have so much to do and for the first time in ages it feels SO overwhelming, I could probably get some of it done in an hour or two, but I just want to curl up on the couch and cry and/or vomit instead.

I did this to myself in undergrad a lot. I used to volunteer as an EMT, take 19+ credits a semester, worked as a research assistant for an animal welfare agency, worked full time, and volunteer at a zoo and stable on the weekends in undergrad...I would GO GO GO for a good 4-5 months and then crash and burn for two days, becoming a big ball of tears and hyperventilation. Then I would recover, get back on my feet and GO GO GO again for the next 4-5 months. The frustrating part now is that the amount of hours I put in at the hospital is out of my hands. I would do less if I was allowed, but I am required to work these insane hours to graduate. I know I need to be social and get out to be sane, but I am getting stressed trying to manage my social life, plus school, plus the various other commitments like running (yes, I need that for my health) and the international certificate program and planning a trip to Australia and trying to do a research project and write a grant proposal for Joerg on exotic animal medicine stuff, and manage my car insurance switch. This sucks, I am torn, do I break down and let it out and let myself cry, and maybe feel better after, or do I keep fighting it and hope this sinking feeling in my throat goes away?

week 2 small animal

week 2 on small animal medicine was pretty uneventful, just really freaking long...I am learning SO much, and I am realizing I know more then I thought. I am being taught great ways to manage cases and am starting to feel like "Wow, I am going to be a doctor in one year, and I will probably be a pretty good one!"
The hours this week have gotten me to school by 530 am almost every day, and I can't leave until 6-8pm. The only rough day was Tuesday when I took on more then I could chew. I got there at 6am, I had one case in the hospital already, and I took two transfers, but it just happens that I picked the two most complicated cases, so I struggled with them, but the doctors complimented me after since they were tough cases.

Case 1: an 8 year old cat withchronic renal failure that was JUST diagnosed, her BUN=180, her creatinine was 30!!! (anything over 15 is considered not really compatible with life). Well sadly the options were hemodialysis or euthanasia, so after all my hard work in the morning the owners opted for euthanasia (can't blame them, I probably would of too).

Case 2: a 6 year old golden retriever with a week of inappatence, vomiting, diarrhea, and melena (blood in the stool). The day before she had an episode of collapse and was brought to the ER. She was pale, icteric (yellow tinge from liver disease) and weak as hell Her pulses were crappy, and I thought she was going to die on me. Her bloodwork was crazy and showed severe liver damage. We signed her up for an abdominal ultrasound with a liver biopsy so we could see if it was hepatitis, cancer, or hyperplasia of her liver (some are treatable, some are not).
Well the craziness happened at 4pm when she got her ultrasound...yes her liver was fucked up, but they also found what looked like a long thin stick in her colon with thickened colon walls and fluid around it...the ultrasound people thought she might have had a teriyaki stick foreign body that perforated her colon and was causing her abdomen to be septic (severely infected).
The owners came to visit and we explained all this. It was a really good talk with the owners, and they said that had had teriyaki 4 nights ago! We explained that her liver was messed up, and she was VERY sick but it could also be that the stick perforated her colon and was making her septic. Theoretically, surgery could repair the hole from the stick and clean up her abdomen, and she might live, but it was a poor prognosis. We explained costs (over $4000 if successful) and told them that honestly the only options were euthanasia or surgery, and that either option was a good one. At this point there teenage son ran out of the room trying to hold in his tears until he got in the hall, at which point he screamed and ran outside to cry on his own. We tried hard not to make them think they needed to go to surgery since the dog was so sick she might not survive, but being a golden retreiver she perked up in the exam room, was trying to run around and wag her tail since she was so happy to see her owners. So her owners decided they wanted to try for surgery knowing the odds were not great.
So surgery...I was not on surgery, but being the student on the case I stayed late to watch and participate a bit...7pm we opened her up, and no stick or perforation was found...what was found was a HUGE mass on intestines blocking its blood supply that was bleeding out, and masses all throughout her liver. She started bleeding out so quick we hooked her up to a transfusion. The surgeon got a good look and explained he could not resect the mass without killing the dog's intestines, so the options were:1. euthanize on the table or 2. sew her up and let the owners see her alive (but comatose) one more time before euthanizing....we talked with the owners on the phone, I really liked the family and almost cried, but we decided to euthanize on the table, which was good since the dog started to die on her own as we did it. So sad, it was a long and rough night then.

The rest of the week was long hours but my patients did better then that rough day. I made lasagna but didn;'t back in on wednesday so that thursday after school I drove in to boston and cooked it for mark and I. we had a fun night but I did not get nearly enough sleep as always, but it was worth it since I am so smitten lately.

Today I had my second evaluation, this one from Dr. Lapelle. I heard from some classmates on medicine a couple weeks ago she was kind of tough on them in evals, so I was prepared for the worst. But I got lucky again. She was really nice and said I was doing a great job. She said my only problem was that I was not confident enough in myself. She said I should trust my instincts an speak up in rounds more since I often know the answer and seem to hesitate and question myself too much. Pretty nice eval, I was happy...maybe Dr. Freeman was right and clinics will really boost my GPA, since I am thinking with these evals I might be on my way to an A in most of my rotations.

Of course, sadly, my social life is suffering a bit, there is never enough time. I got invited to 6 parties this week, and I have missed the first 4 already due to my long hours...hopefully I can make the two this weekend.

a size 2? no fucking way...

I am not sure if Mark is a good or bad influence, well, he is not bad, but I am doing things I never thought I would thanks to him. I have def. always been a tom boy, and my "dress up" outfits for me are rather loose fitting, etc. I have toned up a lot from running, and Mark has somehow convinced me that I need to "dress up" more, show off my assets, etc. I was getting frustrated since I thought I was dressing up, but I convinced him that we needed to go shopping together since what I think is dressed up is not enough for him, and he should just pick out some clothes for me. I was shocked when he happily agreed. We went to the mall in Cambridge on Sunday morning, and he said we should find me a tight pair of jeans...
First stop: Macy's. Now I used to be a size 10, lost some weight a year ago, went to a size 8, and recently my size 8's are big and I wear a size 6 comfortably. I have NEVER been smaller then that since 9th grade. Well, I told Mark I wear a size 6 most of the time, and he told me to try a size 4. I did, and they fit loosely! I was feeling quite confident, and tried on the same pair in 2, and they were tight, but they fit, and NO trouble buttoning them! (just tighter then I am used too). We agreed I fit in them, but they were too long, so we headed on to stop #2.
Stop #2: Express...All jeans are $60 but my friends rant and rave about them. We pulled off too different styles off the shelf, in size 2 and 4...sadly I went in to the fitting rooms and the size 2 was too tight, could barely close the button, but that's ok. So size 4 in pair #1 was ok, but not amazing. Went on the pair #2 in size 4, which was a low hip style. They fit, but I felt quite vulnerable since I am not used to the low rise hip style, I felt very exposed. I came out, and Mark smiled and said they looked nice. I started explaining why I felt weird in them, but then suddenly the express worker walked by and stopped and said "Those look great on you!" I guess I made a face cause she came over and asked "Why don't you like them?" I started explaining when another costumer walked by and commented "Wow, those look great on you!" and then she whispered loud enough for Mark to hear "Your ass looks great in them too" I laughed, by this time Mark was just standing aside beaming as the girls started analyzing how hot I looked in the jeans. In response to my feeling they were too low, the girls said I needed to go back in the fitting room and squat, and as long as my ass didn't show I was ok. I looked at Mark and he just smiled and said "You look great." So I passed the squat test and Mark was shocked when I came out and said I would buy them but my response was "Well, three against one, I think I have the support form the masses." Mark tried to help and pay for some of them, but I just told him he could make it up to me when we go out and I wear them next by buying all my drinks and dinner that night.
Today was day one of week two on medicine. It was ok. I didn't do a good job in the morning cases, but I made up for it in the afternoon by writing some great discharges as well as surprising myself with my knowledge when the doctors grilled me on my differentials for various cases. This week is def. a lot more busy then last, plus I have tons of parties! We'll see what happens!
: )

evals...

I hate to brag, but am feeling alittle proud right now...I know only a couple people read this, so this is my time to brag I guess.
So on small animal medicine your clinician gives you a one onone evaluation at the end of the week...today was the end of week one, and my eval was great. I know I am a hard worker, but at times I am scared I don't know enough, and at other times I have no idea what people think of me. Well, Dr. Wells gave me my eval today (names changed again) and it went great.

She told me that on day one I was quiet and she was scared I was "going to be one of those students who is always quiet and who I never know if they know anything" but then I opened up by day two. She said she was very impressed with my knowledge base at this point in clinics. She said that her and Dr. Harris were incredibly impressed with my efficiency and how pro-active I was. They said I was one of the most organized people they had met and I was always surprising them with things before they could ask me to do it. She said if I do an internship I will be top of my class cause my organization and efficiency skills will be hard to match. She said that I was always helpful and pleasant to work with, and that she was impressed with how much I helped my two fellow classmates on with me since I was always ahead so I was always available to offer them an extra hand. At the end she said that they ask the clinicians to find one thing to tell students they could improve on, but Dr. Wells told me it was hard to find something for me at this point..she said that if she had to be critical she would say that I was too efficient and on top of things cause sometimes I would have test results and other info before the clinicians were ready to deal with it.

Ok, done bragging...sorry, but I am a little proud now. Of course, I still feel completely incompetent in some of my hands on skills. I have so much more to learn in the next year in clinics, this is only the beginning, and even though I am a personable and hard working person I know I do have a lot to improve on.

fast pace Lindsey

Note: I changed names of vets here for privacy reasons...this is on the web after all! Hopefully I didn't miss one of the names and forget to replace it with its fake name!

Week 1: small animal medicine...you learn a lot in clinics. I thought I was much more of a medicine person before this week, but a lot has changed I guess. Overall it has been good, just REALLY SLOW. You spend so much time analyzing every inch of history on medicine. There is no quick answer at Tufts since the cases are so complicated. And you hardly have more then 3 patients in the hospital since each one is on 5+ drugs and has 24 hour treatments you need to manage. Before clinics I thought I would love medicine and hate surgery. Now that I have had a taste of both I wish I was still on surgery! Sure the on call hours and case load was intense, but I like managing that much as opposed to one patient a day.

Dawn, the lab tech from Dr. Warren's lab that I used to work with, was walking by today while i read a chart I was about to go in to a room with...she stopped by to ask how I was liking clinics and if I had survived surgery. I whispered to her how surprised I was that I think I liked surgery t=more then medicine. She laughed and said the two were very different paces and the "fast pace Lindsey" she knew to always be managing twenty million things so efficiently would like surgery more, she was not surprised. She told me she couldn't wait for me to do my emergency and critical care rotation since she thinks that will suit my fast paced personality best.

I was bitching to Mark that we see the most complicated, rare, weird disorders at Tufts since all the local vets refer their weird cases they can't solve to us...it is cool, but annoying sometimes since it is not realistic, I will rarely see these cases in practice. Well, today was one of those days where I couldn't stop giggling and wanted to tell Mark about those cases...we saw a german short haired pointer with "caudal vena cava aplasia" today. It is basically a weird and wrong arrangement of blood vessels in the caudal half of the dog...there have only been about 6 cases reported EVER in the history of the world, and of course only one case ever treated successfully, so we will hopefully have number two....if the dog throws a clot we will try to be the second institution ever to fix a dog with this weird disorder. Here's the one case before: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=339271

One of my other patients today was a recheck patient with SLE, or Systemic Lupus Erythematosus, a VERY rare autoimmune disorder in all species (humans get it too). The dog was doing great. It was this really nice couple in their late 50's who were convinced their dog was going to die a month ago, but we figured out it had this disorder and brought it back, she is doing great now. Still not 100%, but 20x better then when she left the hospital a week ago.

The other weird/nice thing that happened today was involving the resident....right now Jaime, me and Jess (three senior students) are on with Dr. Wells, a board certifiied internal medicine clinician, and Dr. Harris, the second year medicine resident (it is a three year program for her to get her internal medicine certificate). Both are great. Dr. Wells is brilliant. Well, Dr. Harris has been working on this intense bile peritonitis, renal agenisis and failure, etc. problem dog...the dog is nasty to us, but has every problem in the book. However, the dog has the most incredible owner, and the dog and the owner are bonded beyond belief. A lot of owners claim "Oh, my dog wont bite if I am here" which is BS, and the dog lashes out of fear and hurts someone. This owner does not claim that, but it is TRUE. When the dog is with the owner she is in heaven and does ANYTHING for him, we can put catheters in or do an ultrasound, I honestly think the dog would let us cut her open and do surgery if the owner was there to tell her to stand still, she is that fucking loyal, but once he is gone she needs a muzzle since she tries to eat us. This dog has been in and out of the hospital every week for the last three months, and the owner talks to Dr. Harris every day. Dr. Harris told us today the owner has spent over $18,000 on the dog in surgeries and diagnostics...

Well she is back now, and her one kidney (renal agenesis means she was only born with one) is failing...we did tons more tests today, the one kidney has tons of infarcts, her chest is filling with fluid, etc. Not good. We were rounding on her this afternoon in front of her cage, and even though the dog would growl and show her lips Dr. Hilling insisted on sitting in the cage with her. Dr. Harris told us the story of everything that she has done medically with the dog in the last 3 months, and Dr. Harris has had a cold so to me she seemed out of it, but I assumed cause she was sick...when suddenly Dr. Wells said to her "Karrie, you need to realize you did nothing wrong. Everything you did in this dog was right and it is not your fault that she has so many medical problems." I had not even realized that Dr. Harris was stressed about that, but I was so impressed with Dr. Wells's incredible intuition and picking up on Dr. Harris's body language. Suddenly Dr. Harris burst in to tears, and I felt really bad....Dr. Wells comforted her and told her that she had done all the right things, and it was ok to cry, cause if she didn't maybe she should be looking for a different career. She told us all that we should all be proud when a case makes us cry cause we try so hard in vain to save them and it was ok. It was a really weird and happy and sad moment all at once.

On a good side note, progressive car insurance started providing in Massachusetts today..I got my quote, and I can't believe it is actually $600 less then it was in NY annually. So I am all set on car insurance, and should have Mass plates by late May!